关键词: 自体动静脉内瘘, 血液透析, 麻醉, 选择性神经阻滞, 局部浸润麻醉

Abstract: Ｏｂｊｅｃｔｉｖｅ：To evaluate the efficacy of selective nerve block in the creation of arteriovenous fistulas and its effect on arteriovenous fistula maturation.
Ｍｅｔｈｏｄｏｌｏｇｙ：A retrospective cohort study. Patients who underwent arteriovenous fistula anastomosis in Haidian Hospital，the Third Hospital of Peking University from January 1 to December 31，2022 were divided into selective nerve block group and local infiltration anesthesia group according to the type of anesthesia before operation.The visual analogue pain score （VAS），the diameter of anastomotic vessels and the blood flow of brachial artery at immediately，4 weeks，8 weeks and 12 weeks after operation were compared between the two groups，and the fistula maturation was compared between the two groups.
Ｒｅｓｕｌｔｓ：A total of 207 patients were included，including 44（21.26%） patients in selective nerve block group and 163（78.74%） patients in local infiltration anesthesia group. Compared with the local infiltration anesthesia group，the selective nerve block group had smaller preoperative anastomotic diameter（P<0.05），lower intraoperative VAS score（Z=-2.598，P=0.009），larger anastomotic vein diameter and brachial artery blood flow at 5 minutes after anesthesia（P<0.05）. The internal diameter of cephalic vein and brachial artery blood flow of internal fistula in selective nerve block group were significantly higher than those in local infiltration anesthesia group （P<0.05）. At 4 and 8 weeks，the fistula maturation in selective nerve block group was significantly higher than that in local infiltration anesthesia group （P<0.05）. There was no significant difference between the two groups for AVF maturation at 12 weeks （X2=1.616，P=0.204）.
Ｃｏｎｃｌｕｓｉｏｎ：Selective nerve block can provide safe and effective analgesia for AVF anastomosis，and has the advantages of increasing vascular diameter，postoperative internal fistula blood flow and improving short-term fistula maturation. It is a suitable anesthetic method for AVF anastomosis，especially for patients with smaller vascular diameter.

Key words: arteriovenous fistula, hemodialysis, anesthesia, selective nerve block, local infiltration anesthesia